RN Utilization Review Clinician

University Medical Center, Inc.; Louisville (KY); On-site; USD 70,000 - 98,000; Full time

Job summary

UofL Health is seeking an Utilization Review RN to support the UM process, including admission decisions and concurrent reviews. You will collaborate with physicians, case managers, and payors to ensure appropriate utilization and financial accountability.

The role requires RN licensure in Kentucky, 2 years of RN experience, and knowledge of CMS/MCG criteria. A BSN is preferred, with opportunities for growth in care coordination.

Qualifications

• ADN or Associate’s degree in nursing required.
• BSN preferred; RN with business/healthcare admin background acceptable if enrolled in BSN within 1 year and completes within 3 years.
• Two years’ RN experience required; 3 years in behavior health for Peace Hospital.

Responsibilities

• Conduct admission and concurrent utilization reviews for designated services.
• Certify medical necessity for admission, continued stay, and discharge.
• Communicate with payors to obtain authorization and document approvals.
• Educate physicians, patients, and staff on payors, documentation, and compliance.

Skills

RN

Care coordination

Utilization review

Communication

Education

ADN/Associate's degree in nursing

BSN preferred

RN with bachelor's in business/Healthcare Admin or equivalent

Tools

Case Management Software

EMR/EHR

Job description

UofL Health is seeking an Utilization Review RN to support the UM process, including admission decisions and concurrent reviews. You will collaborate with physicians, case managers, and payors to ensure appropriate utilization and financial accountability.

The role requires RN licensure in Kentucky, 2 years of RN experience, and knowledge of CMS/MCG criteria. A BSN is preferred, with opportunities for growth in care coordination.